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Organization

LISA A IACOFANO MD PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LISA ANN IACOFANO M.D. (OWNER/PHYSICIAN)
(303) 665-0900
Entity
Organization

Contact information

Practice address
335 W SOUTH BOULDER RD, SUITE 6, LOUISVILLE, CO 80027-1196
(303) 665-0900
(303) 926-1986
Mailing address
PO BOX 21150, BOULDER, CO 80308-4150
(303) 665-0900
(303) 926-1986

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
31267
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01312677
CO
Enumeration date
06/03/2008
Last updated
01/22/2020
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